"The NHS will last as long as there are folk left with the faith to fight for it"Aneurin Bevan

Friday, 11 February 2011

Nick Clegg and the NHS

It is clear that the blue Liberal Nick Clegg is the big disappointment of last year's election. He fooled many people into thinking that he would stay Osborne's axe, but it is clear that him and his Orange Book colleagues were just as much small statists as Cameron, desperate to destroy our public services. There will always be a place for Clegg in the Conservative party.

However, it didn't fool me. His interview with the Independent in 2005 where he said that he wanted the NHS "broken up", that frightened me (I blogged about it before the election here). After the election I read the Liberal Democrat plans for the NHS and that frightened me too (as you can read here).

Nick Clegg does not believe in public services and so he is well suited in his partnership with David Cameron. As more policies are unveiled by the government, heralding the great sell-off of our services the public are starting to get very twitchy. In fact they are getting worried. Yesterday Nick Clegg attempted to calm the natives with his "Speech on the future of the public sector". In this, he talked about the NHS, but rather than quoting Bevan, he quoted Beveridge. This is an obvious choice because Beveridge was a Liberal and he did a lot of the foundation work that lead to the creation of the NHS. However, it is important to note that the NHS is not the service that Beveridge designed: it is Bevan's NHS, not Beveridge's. It is pointless of Clegg to quote him, unless, of course, Clegg wants to make a political point.

Beveridge’s report said the Department of Health should, and I quote, “supervise” the new health service, not run it.

See what he has done there? Because Beveridge said that the state should not have a responsibility to provide healthcare, Clegg is now saying that the state should not have a responsibility for healthcare provision. This harks back to Clegg's Orange Book inspired quote that he wants to break up the NHS.

He goes on:

And Liberals argued for local government to have a role in the NHS right from its founding, for fear that a fully centralised system would put too much power in the hands of central government instead of the professionals and the patients. The logic of Andrew Lansley’s reforms is precisely to reverse this imbalance: to put power within the NHS in the hands of those who understand patients, the GPs, in those who are accountable to patients, the local authority.

This is a complete misunderstanding of the Health Bill. The Health and Well Being boards proposed by the Bill are just a re-vamp of the local authority Health Scrutiny boards, they do not give more power into the hands of the local authority. (And anyway, why give that power to local councillors, why not give it to service users: patients?) And the so-called "GP-led consortia" don't even have to be led by a GP! They don't even have to have a GP on their board! I really do wonder if Clegg has read the Bill.

Certainly Clegg has been infected with the government's lack of rigour when it comes to statistics:

Health inequalities and the gap in achievement between poor children in different parts of the country actually worsened under Labour.

While it is true that the difference between the life expectancy of the richest and the poorest has increased in the last decade, what he fails to acknowledge is that this increase in health inequalities has been a trend since the 60s!

The term "health inequality" conjures up images of the poor suffering ill health. However, it is significant that over the last decade the life expectancy of the poorest has increased, that is a real achievement, the poor are getting healthier and living longer. The problem (if you can describe it as a problem) is that the life expectancy of the rich has also increased, but faster than the increase of the poor. So what should we do, introduce euthanasia for the rich? That will certainly have an effect on health inequalities! For those interested, I had a rant when Cameron made the same point. Basically the poor are more likely to smoke than the rich and the most significant public health policy of the last government (the smoking ban, which has led to large numbers of people giving up smoking) will only show outcomes in many years time. I am sure that in a decade's time there will be much smaller health inequality because of the effects of the smoking ban.

Another problem with the term is that people tend to think it means the same as equity of access. This is not correct: health inequality is not the same as access to healthcare (although the latter will have an effect on the former). In fact according to the Commonwealth Fund the NHS is the most equitable system: everyone has equal access.

The NHS of Bevan was about access to healthcare: the very poorest should have access to as high quality healthcare as the very richest. (However, as I outlined yesterday, this is not the case under the current government. Prisoners are being given cut-price, lower quality, primary care that the rest of us because the contract was awarded on price only and not on quality.) The Health Bill will devolve so much decision making that we will end up with a healthcare lottery. There will be "winners", but sadly, there will be "losers" and the "losers" are more likely to be in the poorer areas (the Inverse Care Law). In any healthcare system there should never be losers, if there are, then the system needs a re-design.

Clegg stumbles on:

The UK has one of the worst mortality rates amenable to healthcare among rich nations.

This had been comprehensively dismissed by Prof John Appleby, yet Clegg was still using this excuse, why? It shows deep level of desperation to use a statement when you know it is misleading.

Why can’t I register with any GP I want?

Well Mr Clegg, why don't you ask a GP why we have defined GP boundaries? Try this explanation from the excellent Jonathon Tomlinson. There is a reason for most things, Mr Clegg, and if you want to change a policy you have to address the reasons why that policy existed. Lansley's policy does not mitigate the dangers of being able to choose any GP.

There is no liberal reason why those who deliver public services must always work directly for the government - so long as we are absolutely clear about the principles under which those services operate.

This statement made me chuckle. The reason is that I have heard this before and I argued vociferously that NHS workers do not "work directly for the government". It is a nonsense statement of the utmost order. The previous time I heard this statement it omitted the word "liberal" for obvious reasons: it was spoken by Arvin, an American Tea Partier I know, who thinks that the United States is close to collapse and anarchy because of Obama's healthcare reforms. It's amazing that Arvin and Nick are so a like.

My philosophy is simple: unlike the Conservative governments of the past, I believe you have to fund public services well. But unlike the Labour governments of the past, I believe public sector monopolies almost never spend that money best.

So why don't you spell it our Mr Clegg? If "public sector monopolies" don't spend money well, the implication is that you take the services out of public ownership, right? What is that called Mr Clegg? I spy with my little eye, something beginning with P:

In our public services, we need diversity of provision. Because no one person and no one organisation has all the right answers. So, as we modernise public services in the years to come, I will take a hard line against monopolies because they stifle innovation. New and alternative providers - from the private, community and voluntary sectors - have a vital role to play in our public services.

I agree that no one person has all the right ideas (step forward Mr Lansley, and accept that you may be wrong...) but the whole point of a collaborative, rather than a competitive, system is that it is easy to apply best practice across the whole system. The problem with the system being created by Lansley is that when you introduce profits into the system there is no incentive to share innovations, because the innovations are where the profits come from.

Here's a clue or you Mr Clegg. Most of our fundamental science research is publicly funded, the reason is that private companies are not willing to take the risk inherent in the process of innovating.

My first job was as a post-doc in the Physics Department at Nottingham University (I started my post-doc the same year that Andre Geim also started a post-doc in the same department. I worked for a different group, my group had the big lasers.) Nottingham is well known for Prof Sir Peter Mansfield who was awarded the Nobel prize for his work on MRI (or as we physicists call it, Nuclear Magnetic Resonance). The point is that the important early work on MRI was publicly funded. It was only when it was clear that the technique worked and was useful, that manufacturers started to get interested. Without the public funding, and the work of publicly employed scientists, we would not have MRI. University professors are as much part of a government monopoly as NHS surgeons are.

When I started my PhD at Nottingham the department had just taken delivery of a second-hand Molecular Beam Epitaxy machine. They had bought the machine cheap from Phillips Research, who were closing down their semiconductor research facility in the UK. The reason was because the beancounters looked at the cost of the machine, looked at the annual running costs, and looked at the revenue from the machine and decided that they would get more if they sold the machine. The irony was that soon after the machine was up and running in our department UK regulators gave the green light for satellite TV. Satellite dishes used a special high frequency transistor called a HEMT that could only be made using an MBE machine, but Phillips had sold theirs to Nottingham! The private sector had clearly failed.

I will take a hard line, too, against any attempts to replicate the mistake of skewing the market against public sector providers, effectively bribing private companies by offering them more money to do exactly the same job as you. That was wrong.

::Cough:: Have a look at this will you? Lansley is creating a rigged system.

I categorically do not believe that private providers are inherently better than public sector providers

If that is the case, why use them at all? You said above: "providers - from the private, community and voluntary sectors - have a vital role to play in our public services". Are you deliberately trying to contradict yourself?

This is yet another poor Clegg speech. It is full of platitudes, contradictions and assertions without evidence. And this man is the deputy Prime Minister.